Octreotide therapy in patients with a left ventricular assist device and bleeding gastrointestinal angiodysplasias.

Abstract

Background: Angiodysplasias commonly develop in patients with left ventricular assist devices (LVADs) and often bleed recurrently. Whether octreotide reduces the burden of angiodysplasia or the frequency of bleeding in these patients is controversial. Hence, we aimed to study the effect of long-acting octreotide on angiodysplasia bleeding in LVAD patients.

Methods: Between May 2012 and December 2023, 65 patients with LVAD and angiodysplasia were identified at our tertiary care medical center. Of those, 33 patients received octreotide therapy. Complete clinical data were abstracted from the medical record, and outcomes pre and post octreotide therapy were examined.

Results: In 33 patients (61±8 years old and 9 women) who received long-acting octreotide for recurrent angiodysplasia bleeding that failed to respond to endoscopic therapy, the small intestine was the most common site involved. Prior to octreotide, patients received an average of 2.0±3.0 units/month of PRBCs over an average of 16 months, which decreased to 0.5±0.8 units/month over 31 months on therapy. Over an average period of 31 months on octreotide therapy, GI bleeding events and the number of endoscopic therapies per month decreased from 0.4±0.2 to 0.1±0.2 (p= 0.01) and from 0.7±0.8 to 0.1±0.2 (p= 0.001), respectively. Finally, hemoglobin and hematocrit levels increased over the 31 month follow-up period while on octreotide therapy.

Conclusion: In patients with an LVAD and recurrent angiodysplasia bleeding, octreotide appeared to reduce the number of GI bleeding events, the need for GI endoscopic therapies, and the frequency of PRBC transfusions.